Pharmaceutical compositions based on anticholinergics and nk1-receptor antagonists

ABSTRACT

The present invention relates to novel pharmaceutical compositions based on anticholinergics and NK 1 -receptor antagonists, processes for preparing them and their use in the treatment of respiratory tract diseases.

[0001] This application is a continuation in part and claims the benefitof prior provisional application U.S. Serial No. 60/281,653, filed Apr.5, 2001.

[0002] The present invention relates to novel pharmaceuticalcompositions based on anticholinergics and NK₁-receptor antagonists,processes for preparing them and their use in the treatment ofrespiratory diseases.

DESCRIPTION OF THE INVENTION

[0003] The present invention relates to novel pharmaceuticalcompositions based on anticholinergics and NK₁-receptor antagonists,processes for preparing them and their use in the treatment ofrespiratory diseases.

[0004] Surprisingly, an unexpectedly beneficial therapeutic effect,particularly a synergistic effect can be observed in the treatment ofinflammatory and/or obstructive diseases of the respiratory tract if oneor more, preferably one, anticholinergic is used with one or more,preferably one, NK₁-receptor antagonist. In view of this synergisticeffect the pharmaceutical combinations according to the invention can beused in smaller doses than would be the case with the individualcompounds used in monotherapy in the usual way.

[0005] The combinations of active substances according to the inventionare surprisingly also characterised by a rapid onset of activity andalso by a long-lasting effect. This is of great importance to thewellbeing of the patient as on the one hand he experiences a rapidimprovement in his condition after the combination has been administeredand also thanks to the long-lasting effect it is sufficient to take thedrug once a day. The effects mentioned above may be observed both whenthe two active substances are administered simultaneously in a singleactive substance formulation and when they are administered successivelyin separate formulations. According to the invention, it is preferableto administer the two active substance ingredients simultaneously in asingle formulation.

[0006] Within the scope of the present invention the termanticholinergics 1 denotes salts which are preferably selected fromamong tiotropium salts, oxitropium salts and ipratropium salts, mostpreferably ipratropium salts and tiotropium salts. In theabove-mentioned salts the cations tiotropium, oxitropium and ipratropiumare the pharmacologically active ingredients. Within the scope of thepresent patent application, any reference to the above cations isindicated by the use of the number 1′. Any reference to compounds 1naturally also includes a reference to the ingredients 1′ (tiotropium,oxitropium or ipratropium).

[0007] By the salts 1 which may be used within the scope of the presentinvention are meant the compounds which contain, in addition totiotropium, oxitropium or ipratropium as counter-ion (anion), chloride,bromide, iodide, methanesulphonate or para-toluenesulphonate. Within thescope of the present invention, the methanesulphonate, chloride, bromideand iodide are preferred of all the salts 1, the methanesulphonate andbromide being of particular importance. Of outstanding importanceaccording to the invention are salts 1 selected from among tiotropiumbromide, oxitropium bromide and ipratropium bromide. Tiotropium bromideis particularly preferred.

[0008] Within the scope of the present invention, the word NK₁-receptorantagonists (hereinafter 2) denotes compounds selected from amongN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-cyclopropylmethyl-piperazin-1-yl}-N-methyl-2-phenyl-acetamide(BIIF 1149), CP-122721, FK-888, NKP 608C, NKP 608A, CGP 60829, SR48968(Saredutant), SR 140333 (Nolpitantium besilate/chloride), LY 303870 (Lanepitant), MEN-11420 (Nepadutant), SB 223412, MDL-105172A,MDL-103896, MEN-11149, MEN-11467, DNK 333A, SR-144190, YM-49244,YM-44778, ZM-274773, MEN-10930, S-19752, Neuronorm, YM-35375, DA-5018,Aprepitant (MK-869), L-754030, CJ-11974, L-758298, DNK-33A, 6b-I,CJ-11974, TAK-637, GR 205171 and the arylglycinamide derivatives ofgeneral formula 3

[0009] wherein

[0010] R¹ and R² together with the N to which they are bound form a ringof formula

[0011] wherein r and s are 2 or 3;

[0012] R⁶ denotes H, —C₁-C₅-alkyl, C₃-C₅-alkenyl, propynyl,hydroxy(C₂-C₄)alkyl, methoxy(C₂-C₄)alkyl,di(C₁-C₃)alkylamino(C₂-C₄)alkyl, amino(C₂-C₄)alkyl, amino,di(C₁-C₃)alkylamino, monofluoro to perfluoro(C₁-C₂)alkyl,N-methylpiperidinyl, pyridyl, pyrimidinyl, pyrazinyl or pyridazinyl,

[0013] R⁷ has one of the meanings (a) to (d),

[0014] (a) hydroxy

[0015] (b) 4-piperidinopiperidyl,

[0016] (c)

[0017] wherein R¹⁶ and R¹⁷ independently of each other denote H,(C₁-C₄)alkyl, (C₃-C₆)cycloalkyl, hydroxy(C₂-C₄)alkyl,dihydroxy(C₂-C₄)alkyl, (C₁-C₃)alkoxy(C₂-C₄)alkyl, phenyl(C₁-C₄)alkyl ordi(C₁-C₃)alkylamino(C₂-C₄)alkyl,

[0018] R⁸ denotes H,

[0019] optionally in the form of the enantiomers and mixtures ofenantiomers thereof, optionally in the form of the racemates thereof.

[0020] The abovementioned compounds of formula 3 are known for examplefrom International Patent Applications WO 96/32386 and WO 97/32865, towhich reference is hereby made in their entirety.

[0021] Preferably, the compound 2 is selected from among BIIF 1149,CP-122721, CGP 60829, MK-869, CJ-11974, GR 205171 and thearylglycinamide derivatives of general formula 3, wherein R¹ and R²together with the N to which they are bound form a ring of formula

[0022] wherein s is 2 or 3;

[0023] R⁷ denotes a group

[0024] wherein R¹⁶ and R¹⁷ independently of each other denote H,(C₁-C₄)alkyl, (C₃-C₆)cycloalkyl, hydroxy(C₂-C₄)alkyl,dihydroxy(C₂-C₄)alkyl, (C₁-C₃)alkoxy(C₂-C₄)alkyl, phenyl(C₁-C₄)alkyl ordi(C₁-C₃)alkylamino(C₂-C₄)alkyl,

[0025] R⁸ denotes H,

[0026] optionally in the form of the enantiomers and mixtures ofenantiomers thereof and optionally in the form of the racemates thereof.

[0027] Particularly preferably, the compound 2 is selected from amongBIIF1149 and the arylglycinamide derivatives of general formula 3,wherein

[0028] R¹ and R² together with the N to which they are bound form a ringof formula

[0029] wherein s is 2 and

[0030] R⁷ denotes a group

[0031] wherein R¹⁶ and R¹⁷ independently of each other denote H,(C₁-C₄)alkyl, (C₃-C₆)cycloalkyl, hydroxy(C₂-C₄)alkyl ordihydroxy(C₂-C₄)alkyl, R⁸ denotes H, optionally in the form of theenantiomers and mixtures of enantiomers thereof and optionally in theform of the racemates thereof.

[0032] Most particularly preferred as compounds of formula 2 areN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-(4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-(4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl)-N-methyl-2-phenyl-acetamideandN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide,optionally in the form of the enantiomers and mixtures of enantiomersthereof and optionally in the form of the racemates thereof.

[0033] Of particular importance isN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide,optionally in the form of its enantiomers, preferably in the form of its(S)-enantiomer, optionally in the form of the mixtures of enantiomersthereof, and optionally in the form of the racemates thereof.

[0034] Examples of alkyl groups (including those which are part of othergroups), unless otherwise defined, are branched and unbranched alkylgroups with 1 to 5 carbon atoms, such as, for example: methyl, ethyl,propyl, 1-methylethyl (isopropyl), n-butyl, 1-methylpropyl,2-methylpropyl, 1,1-dimethylethyl (tert.butyl), etc. The definitionspropyl, butyl and pentyl always include the associated isomeric groups.Hydroxy or dihydroxyalkyl groups are alkyl groups substituted by one ortwo hydroxy groups.

[0035] Examples of alkenyl groups (including those which are part ofother groups) are branched and unbranched alkenyl groups with 3 to 5carbon atoms, provided that they have at least one double bond, such as,for example, propenyl, isopropenyl, butenyl, etc.

[0036] Cycloalkyl generally denotes a saturated cyclic hydrocarbon grouphaving 3 to 6 carbon atoms. Examples include cyclopropyl, cyclobutyl,cyclopentyl, cyclohexyl, cyclopropylmethyl, cyclobutylmethyl,cyclopentylmethyl, cyclopropylethyl, cyclobutylethyl, etc.

[0037] Alkyloxy, which may optionally also be referred to as alkoxy,denotes a straight-chain or branched alkyl group bound via an oxygenatom. The methoxy group is particularly preferred.

[0038] Any reference to the abovementioned NK₁-receptor antagonists 2within the scope of the present invention includes a reference to anypharmacologically acceptable acid addition salts thereof which mayexist.

[0039] By the physiologically acceptable acid addition salts which maybe formed from 2 are meant, for example, pharmaceutically acceptablesalts selected from the salts of hydrochloric acid, hydrobromic acid,sulphuric acid, phosphoric acid, methanesulphonic acid, acetic acid,fumaric acid, succinic acid, lactic acid, citric acid, tartaric acid ormaleic acid. Particularly preferred salts of the compounds 2 accordingto the invention are those selected from among the acetate,hydrochloride, hydrobromide, sulphate, phosphate and methanesulphonate.

[0040] The pharmaceutical combinations of 1 and 2 according to theinvention are preferably administered by inhalation. Suitable inhalablepowders packed into suitable capsules (inhalettes) may be administeredusing suitable powder inhalers. Alternatively, the drug may be inhaledby the application of suitable inhalation aerosols. These also includepowdered inhalation aerosols which contain for example HFA134a, HFA227or a mixture thereof as propellant gas. The drug may also be inhaledusing suitable solutions of the pharmaceutical combination consisting of1 and 2.

[0041] In one aspect, therefore, the invention relates to apharmaceutical composition which contains a combination of 1 and 2.

[0042] In another aspect the present invention relates to apharmaceutical composition which contains one or more salts 1 and one ormore compounds 2, optionally in the form of their solvates or hydrates.Again, the active substances may be combined in a single preparation orcontained in two separate formulations. Pharmaceutical compositionswhich contain the active substances 1 and 2 in a single preparation arepreferred according to the invention.

[0043] In another aspect the present invention relates to apharmaceutical composition which contains, in addition totherapeutically effective quantities of 1 and 2, a pharmaceuticallyacceptable carrier or excipient. In another aspect the present inventionrelates to a pharmaceutical composition which does not contain anypharmaceutically acceptable carrier or excipient in addition totherapeutically effective quantities of 1 and 2.

[0044] The present invention also relates to the use of 1 and 2 forpreparing a pharmaceutical composition containing therapeuticallyeffective quantities of 1 and 2 for treating inflammatory and/orobstructive diseases of the respiratory tract, particularly asthma orchronic obstructive pulmonary disease (COPD), and complications thereofsuch as pulmonary hypertension, as well as allergic and non-allergicrhinitis, provided that treatment with NK₁-receptor antagonists is notcontraindicated from a therapeutic point of view, by simultaneous orsuccessive administration.

[0045] The present invention also relates to the simultaneous orsuccessive use of therapeutically effective doses of the combination ofthe above pharmaceutical compositions 1 and 2 for treating inflammatoryand/or obstructive diseases of the respiratory tract, particularlyasthma or chronic obstructive pulmonary disease (COPD), andcomplications thereof such as pulmonary hypertension, as well asallergic and non-allergic rhinitis, provided that treatment withNK₁-receptor antagonists is not contraindicated from a therapeutic pointof view, by simultaneous or successive administration.

[0046] In the active substance combinations of 1 and 2 according to theinvention, ingredients 1 and 2 may be present in the form of theirenantiomers, mixtures of enantiomers or in the form of racemates.

[0047] The proportions in which the two active substances 1 and 2 may beused in the active substance combinations according to the invention arevariable. Active substances 1 and 2 may possibly be present in the formof their solvates or hydrates. Depending on the choice of the compounds1 and 2, the weight ratios which may be used within the scope of thepresent invention vary on the basis of the different molecular weightsof the various compounds and their different potencies. As a rule, thepharmaceutical combinations according to the invention may containcompounds 1 and 2 in ratios by weight ranging from 1:300 to 50:1,preferably from 1:250 to 40:1. In the particularly preferredpharmaceutical combinations which contain tiotropium salt as compound 1and a compound selected from among BIIF 1149, CGP 60829, MK-869,CJ-11974, GR 205171,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-l-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamide,N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamideandN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamideand the arylglycinamide derivatives of formula 3 as NK₁-receptorantagonist 2, the weight ratios of 1 to 2 are most preferably in a rangein which tiotropium 1′ and 2 are present in proportions of 1:150 to30:1, more preferably from 1:50 to 20:1.

[0048] For example, without restricting the scope of the inventionthereto, preferred combinations of 1 and 2 according to the inventionmay contain tiotropium 1′ and NK₁-receptor antagonist 2 in the followingweight ratios:

[0049] 1:80, 1:79, 1:78, 1:77, 1:76, 1:75, 1:74, 1:73, 1:72, 1:71, 1:70,1:69, 1:68, 1:67, 1:66, 1:65, 1:64, 1:63, 1:62, 1:61, 1:60, 1:59, 1:58,1:57, 1:56, 1:55, 1:54, 1:53, 1:52, 1:51, 1:50; 1:49; 1:48; 1:47; 1:46;1:45; 1:44; 1:43; 1:42; 1:41; 1:40; 1:39; 1:38; 1:37; 1:36; 1:35; 1:34;1:33; 1:32; 1:31; 1:30; 1:29; 1:28; 1:27; 1:26; 1:25; 1:24; 1:23; 1:22;1:21; 1:20; 1:19; 1:18; 1:17; 1:16; 1:15; 1:14; 1:13; 1:12; 1:11; 1:10;1:9; 1:8; 1:7; 1:6; 1:5; :1:4; 1:3; 1:2; 1:1; 2:1; 3:1; 4:1; 5:1; 6:1;7:1; 8:1; 9:1; 10:1; 11:1; 12:1; 13:1; 14:1; 15:1; 16:1; 17:1; 18:1;19:1; 20:1.

[0050] The pharmaceutical compositions according to the inventioncontaining the combinations of 1 and 2 are normally administered so that1 and 2 are present together in doses of 0.01 to 10000 μg, preferablyfrom 0.1 to 2000 μg, more preferably from 1 to 1500 μg, better stillfrom 50 to 1200 μg per single dose. For example, combinations of 1 and 2according to the invention contain a quantity of tiotropium 1′ andNK₁-receptor antagonist 2 such that the total dosage per single dose isabout 100 μg, 105 μg, 110 μg, 115 μg, 120 μg, 125 μg, 130 μg, 135 μg,140 μg, 145 μg, 150 μg, 155 μg, 160 μg, 165 μg, 170 μg, 175 μg, 180 μg,185 μg, 190 μg, 195μg, 200 μg, 205 μg, 210 μg, 215 μg, 220 μg, 225 μg,230 μg, 235 μg, 240μg, 245 μg, 250 μg, 255 μg, 260 μg, 265 μg, 270 μg,275 μg, 280 μg, 285 μg, 290 μg, 295 μg, 300 μg, 305 μg, 310 μg, 315 μg,320 μg, 325 μg, 330 μg, 335 μg, 340 μg, 345 μg, 350 μg, 355 μg, 360 μg,365 μg, 370 μg, 375 μg, 380 μg, 385 μg, 390 μg, 395 μg, 400 μg, 405 μg,410 μg, 415 μg, 420 μg, 425 μg, 430 μg, 435 μg, 440 μg, 445 μg, 450 μg,455 μg, 460 μg, 465 μg, 470 μg, 475 μg, 480 μg, 485 μg, 490 μg, 495 μg,500 μg, 505 μg, 510 μg, 515 μg, 520 μg, 525 μg, 530 μg, 535 μg, 540 μg,545 μg, 550 μg, 555 μg, 560 μg, 565 μg, 570 μg, 575 μg, 580 μg, 585 μg,590 μg, 595 μg, 600 μg, 605 μg, 610 μg, 615 μg, 620 μg, 625 μg, 630 μg,635 μg, 640 μg, 645 μg, 650 μg, 655 μg, 660 μg, 665 μg, 670 μg, 675 μg,680 μg, 685 μg, 690 μg, 695 μg, 700 μg, 705 μg, 710 μg, 715 μg, 720 μg,725 μg, 730 μg, 735 μg, 740 μg, 745 μg, 750 μg, 755 μg, 760 μg, 765 μg,770 μg, 775 μg, 780 μg, 785 μg, 790 μg, 795 μg, 800 μg, 805 μg, 810 μg,815 μg, 820 μg, 825 μg, 830 μg, 835 μg, 840 μg, 845 μg, 850 μg, 855 μg,860 μg, 865 μg, 870 μg, 875 μg, 880 μg, 885 μg, 890 μg, 895 μg, 900 μg,905 μg, 910 μg, 915 μg, 920 μg, 925 μg, 930 μg, 935 μg, 940 μg, 945 μg,950 μg, 955 μg, 960 μg, 965 μg, 970 μg, 975 μg, 980 μg, 985 μg, 990 μg,995 μg, 1000 μg, 1005 μg, 1010 μg, 1015 μg, 1020 μg, 1025 μg, 1030 μg,1035 μg, 1040 μg, 1045 μg, 1050 μg, 1055 μg, 1060 μg, 1065 μg, 1070 μg,1075 μg, 1080 μg, 1085 μg, 1090 μg, 1095 μg, 1100 μg or similar. Thesuggested dosages per single dose specified above are not to be regardedas being limited to the numerical values actually stated, but areintended as dosages which are disclosed by way of example. Of course,dosages which may fluctuate about the abovementioned numerical valueswithin a range of about ±2.5 μg are also included in the values givenabove by way of example. In these dosage ranges, the active substances1′ and 2 may be present in the weight ratios given above.

[0051] For example, without restricting the scope of the inventionthereto, the combinations of 1 and 2 according to the invention maycontain a quantity of tiotropium 1′ and NK₁-receptor antagonist 2 suchthat, for each single dose, 5 μg of 1′ and 25 μg of 2, 5 μg of 1′ and 50μg of 2, 5 μg of 1′ and 100 μg of 2, 5 μg of 1′ and 200 μg of 2, 5 μg of1′ and 300 μg of 2, 5 μg of 1′ and 400 μg of 2, 5 μg of 1′ and 500 μg of2, 5 μg of 1′ and 600 μg of 2, 5 μg of 1′ and 700 μg of 2, 5 μg of 1′and 800 μg of 2, 5 μg of 1′ and 900 μg of 2, 5 μg of 1′ and 1000 μg of2, 10 μg of 1′ and 25 μg of 2, 10 μg of 1′ and 50 μg of 2, 10 μg of 1′and 100 μg of 2, 10 μg of 1′ and 200 μg of 2, 10 μg of 1′ and 300 μg of2, 10 μg of 1′ and 400 μg of 2, 10 μg of 1′ and 500 μg of 2, 10 μg of 1′and 600 μg of 2, 10 μg of 1′ and 700 μg of 2, 10 μg of 1′ and 800 μg of2, 10 μg of 1′ and 900 μg of 2, 10 μg of 1′ and 1000 μg of 2, 18 μg of1′ and 25 μg of 2, 18 μg of 1′ and 50 μg of 2, 18 μg of 1′ and 100 μg of2, 18 μg of 1′ and 200 μg of 2, 18 μg of 1′ and 300 μg of 2, 18 μg of 1′and 400 μg of 2, 18 μg of 1′ and 500 μg of 2, 18 μg of 1′ and 600 μg of2, 18 μg of 1′ and 700 μg of 2, 18 μg of 1′ and 800 μg of 2, 18 μg of 1′and 900 μg of 2, 18 μg of 1′ and 1000 μg of 2, 20 μg of 1′ and 25 μg of2, 20 μg of 1′ and 50 μg of 2, 20 μg of 1′ and 50 μg of 2, 20 μg of 1′and 100 μg of 2, 20 μg of 1′ and 200 μg of 2, 20 μg of 1′ and 300g of 2,20 μg of 1′ and 400 μg of 2, 20 μg of 1′ and 500 μg of 2, 20 μg of 1′and 600 μg of 2, 20 μg of 1′ and 700 μg of 2, 20 μg of 1′ and 800 μg of2, 20 μg of 1′ and 900 μg of 2, 20 μg of 1′ and 1000 μg of 2, 36 μg of1′ and 25 μg of 2, 36 μg of 1′ and 50 μg of 2, 36 μg of 1′ and 100 μg of2, 36 μg of 1′ and 200 μg of 2, 36 μg of 1′ and 300 μg of 2, 36 μg of 1′and 400 μg of 2, 36 μg of 1′ and 500 μg of 2, 36 μg of 1′ and 600 μg of2, 36 μg of 1′ and 700 μg of 2, 36 μg of 1′ and 800 μg of 2, 36 μg of 1′and 900 μg of 2, 36 μg of 1′ and 1000 μg of 2, 40 μg of 1′ and 25 μg of2, 40 μg of 1′ and 50 μg of 2, 40 μg of 1′ and 100 μg of 2, 40 μg of 1′and 200 μg of 2, 40 μg of 1′ and 300 μg of 2, 40 μg of 1′ and 400 μg of2, 40 μg of 1′ and 500 μg of 2, 40 μg of 1′ and 600 μg of 2 or 40 μg of1′ and 700 μg of 2, 40 μg of 1′ and 800 μg of 2, 40 μg of 1′ and 900 μgof 2, 40 μg of 1′ and 1000 μg of 2 are administered.

[0052] If the active substance combination in which 1 denotes tiotropiumbromide is used as the preferred combination of 1 and 2 according to theinvention, the quantities of active substance 1′ and 2 administered persingle dose mentioned by way of example correspond to the followingquantities of 1 and 2 administered per single dose: 6 μg of 1 and 25 μgof 2, 6 μg of 1 and 50 μg of 2, 6 μg of 1 and 100 μg of 2, 6 μg of 1 and200 μg of 2, 6 μg of 1 and 300 μg of 2, 6 μg of 1 and 400 μg of 2, 6 μgof 1 and 500 μg of 2, 6 μg of 1 and 600 μg of 2, 6 μg of 1 and 700 μg of2, 6 μg of 1 and 800 μg of 2, 6 μg of 1 and 900 μg of 2, 6 μg of 1 and1000 μg of 2, 12 μg of 1 and 25 μg of 2, 12 μg of 1 and 50 μg of 2, 12μg of 1 and 100 μg of 2, 12 μg of 1 and 200 μg of 2, 12 μg of 1 and 300μg of 2, 12 μg of 1 and 400 μg of 2, 12 μg of 1 and 500 μg of 2, 12 μgof 1 and 600 μg of 2, 12 μg of 1 and 700 μg of 2, 12 μg of 1 and 800 μgof 2, 12 μg of 1 and 900 μg of 2, 12 μg of 1 and 1000 μg of 2, 21.7 μgof 1 and 25 μg of 2, 21.7 μg of 1 and 50 μg of 2, 21.7 μg of 1 and 100μg of 2, 21.7 μg of 1 and 200 μg of 2, 21.7 μg of 1 and 300 μg of 2,21.7 μg of 1 and 400 μg of 2, 21.7 μg of 1 and 500 μg of 2, 21.7 μg of 1and 600 μg of 2, 21.7 μg of 1 and 700 μg of 2, 21.7 μg of 1 and 800 μgof 2, 21.7 μg of 1 and 900 μg of 2, 21.7 μg of 1 and 1000 μg of 2, 24.1μg of 1 and 25 μg of 2, 24.1 μg of 1 and 50 μg of 2, 24.1 μg of 1 and100 μg of 2, 24.1 μg of 1 and 200 μg of 2, 24.1 μg of 1 and 300 μg of 2,24.1 μg of 1 and 400 μg of 2, 24.1 μg of 1 and 500 μg of 2, 24.1 μg of 1and 600 μg of 2, 24.1 μg of 1 and 700 μg of 2, 24.1 μg of 1 and 800 μgof 2, 24.1 μg of 1 and 900 μg of 2, 24.1 μg of 1 and 1000 μg of 2, 43.3μg of 1 and 25 μg of 2, 43.3 μg of 1 and 50 μg of 2, 43.3 μg of 1 and100 μg of 2, 43.3 μg of 1 and 200 μg of 2, 43.3 μg of 1 and 300 μg of 2,43.3 μg of 1 and 400 μg of 2, 43.3 μg of 1 and 500 μg of 2, 43.3 μg of 1and 600 μg of 2, 43.3 μg of 1 and 700 μg of 2, 43.3 μg of 1 and 800 μgof 2, 43.3 μg of 1 and 900 μg of 2, 43.3 μg of 1 and 1000 μg of 2, 48.1μg of 1 and 25 μg of 2, 48.1 μg of 1 and 50 μg of 2, 48.1 μg of 1 and100 μg of 2, 48.1 μg of 1 and 200 μg of 2, 48.1 μg of 1 and 300 μg of 2,48.1 μg of 1 and 400 μg of 2, 48.1 μg of 1 and 500 μg of 2, 48.1 μg of 1and 600 μg of 2, 48.1 μg of 1 and 700 μg of 2, 48.1 μg of 1 and 800 μgof 2, 48.1 μg of 1 and 900 μg of 2, 48.1 μg of 1 and 1000 μg of 2.

[0053] If the active substance combination in which 1 is tiotropiumbromide monohydrate is used as the preferred combination of 1 and 2according to the invention, the quantities of 1′ and 2 administered persingle dose specified by way of example hereinbefore correspond to thefollowing quantities of 1 and 2 administered per single dose: 6.2 μg of1 and 25 μg of 2, 6.2 μg of 1 and 50 μg of 2, 6.2 μg of 1 and 100 μg of2, 6.2 μg of 1 and 200 μg of 2, 6.2 μg of 1 and 300 μg of 2, 6.2 μg of 1and 400 μg of 2, 6.2 μg of 1 and 500 μg of 2, 6.2 μg of 1 and 600 μg of2, 6.2 μg of 1 and 700 μg of 2, 6.2 μg of 1 and 800 μg of 2, 6.2 μg of 1and 900 μg of 2, 6.2 μg of 1 and 1000 μg of 2, 12.5 μg of 1 and 25 μg of2, 12.5 μg of 1 and 50 μg of 2, 12.5 μg of 1 and 100 μg of 2, 12.5 μg of1 and 200 μg of 2, 12.5 μg of 1 and 300 μg of 2, 12.5 μg of 1 and 400 μgof 2, 12.5 μg of 1 and 500 μg of 2, 12.5 μg of 1 and 600 μg of 2, 12.5μg of 1 and 700 μg of 2, 12.5 μg of 1 and 800 μg of 2, 12.5 μg of 1 and900 μg of 2, 12.5 μg of 1 and 1000 μg of 2, 22.5 μg of 1 and 25 μg of 2,22.5 μg of 1 and 50 μg of 2, 22.5 μg of 1 and 100 μg of 2, 22.5 μg of 1and 200 μg of 2, 22.5 μg of 1 and 300 μg of 2, 22.5 μg of 1 and 400 μgof 2, 22.5 μg of 1 and 500 μg of 2, 22.5 μg of 1 and 600 μg of 2, 22.5μg of 1 and 700 μg of 2, 22.5 μg of land 800 μg of 2, 22.5 μg of 1 and900 μg of 2, 22.5 μg of 1 and 1000 μg of 2, 25 μg of 1 and 25 μg of 2,25 μg of 1 and 50 μg of 2, 25 μg of 1 and 100 μg of 2, 25 μg of 1 and200 μg of 2, 25 μg of 1 and 300 μg of 2, 25 μg of 1 and 400 μg of 2, 25μg of 1 and 500 μg of 2, 25 μg of 1 and 600 μg of 2, 25 μg of 1 and 700μg of 2, 25 μg of 1 and 800 μg of 2, 25 μg of 1 and 900 μg of 2, 25 μgof 1 and 1000 μg of 2, 45 μg of 1 and 25 μg of 2, 45 μg of 1 and 50 μgof 2, 45 μg of 1 and 100 μg of 2, 45 μg of 1 and 200 μg of 2, 45 μg of 1and 300 μg of 2, 45 μg of 1 and 400 μg of 2, 45 μg of 1 and 500 μg of 2,45 μg of 1 and 600 μg of 2, 45 μg of 1 and 700 μg of 2, 45 μg of 1 and800 μg of 2, 45 μg of 1 and 900 μg of 2, 45 μg of 1 and 1000 μg of 2, 50μg of 1 and 25 μg of 2, 50 μg of 1 and 50 μg of 2, 50 μg of 1 and 100 μgof 2, 50 μg of 1 and 200 μg of 2, 50 μg of 1 and 300 μg of 2, 50 μg of 1and 400 μg of 2, 50 μg of 1 and 500 μg of 2, 50 μg of 1 and 600 μg of 2,50 μg of 1 and 700 μg of 2, 50 μg of 1 and 800 μg of 2, 50 μg of 1 and900 μg of 2 or 50 μg of 1 and 1000 μg of 2.

[0054] The active substance combinations of 1 and 2 according to theinvention are preferably administered by inhalation. For this purpose,ingredients 1 and 2 have to be made available in forms suitable forinhalation. Inhalable preparations include inhalable powders,propellant-containing metering aerosols or propellant-free inhalablesolutions. Inhalable powders according to the invention containing thecombination of active substances 1 and 2 may consist of the activesubstances on their own or of a mixture of the active substances withphysiologically acceptable excipients. Within the scope of the presentinvention, the term propellant-free inhalable solutions also includesconcentrates or sterile inhalable solutions ready for use. Thepreparations according to the invention may contain the combination ofactive substances 1 and 2 either together in one formulation or in twoseparate formulations. These formulations which may be used within thescope of the present invention are described in more detail in the nextpart of the specification.

[0055] A) Inhalable Powder Containing the Combinations of ActiveSubstances 1 and 2 According to the Invention:

[0056] The inhalable powders according to the invention may contain 1and 2 either on their own or in admixture with suitable physiologicallyacceptable excipients.

[0057] If the active substances 1 and 2 are present in admixture withphysiologically acceptable excipients, the following physiologicallyacceptable excipients may be used to prepare these inhalable powdersaccording to the invention: monosaccharides (e.g. glucose or arabinose),disaccharides (e.g. lactose, saccharose, maltose), oligo- andpolysaccharides (e.g. dextran), polyalcohols (e.g. sorbitol, mannitol,xylitol), salts (e.g. sodium chloride, calcium carbonate) or mixtures ofthese excipients with one another. Preferably, mono- or disaccharidesare used, while the use of lactose or glucose is preferred,particularly, but not exclusively, in the form of their hydrates. Forthe purposes of the invention, lactose is the particularly preferredexcipient, while lactose monohydrate is most particularly preferred.

[0058] Within the scope of the inhalable powders according to theinvention the excipients have a maximum average particle size of up to250 μm, preferably between 10 and 150 μm, most preferably between 15 and80 μm. It may sometimes seem appropriate to add finer excipientfractions with an average particle size of 1 to 9 μm to the excipientmentioned above. These finer excipients are also selected from the groupof possible excipients listed hereinbefore. Finally, in order to preparethe inhalable powders according to the invention, micronised activesubstance 1 and 2,preferably with an average particle size of 0.5 to 10μm, more preferably from 1 to 6 μm, is added to the excipient mixture.Processes for producing the inhalable powders according to the inventionby grinding and micronising and by finally mixing the ingredientstogether are known from the prior art. The inhalable powders accordingto the invention may be prepared and administered either in the form ofa single powder mixture which contains both 1 and 2 or in the form ofseparate inhalable powders which contain only 1 and 2.

[0059] The inhalable powders according to the invention may beadministered using inhalers known from the prior art. Inhalable powdersaccording to the invention which contain a physiologically acceptableexcipient in addition to 1 and 2 may be administered, for example, bymeans of inhalers which deliver a single dose from a supply using ameasuring chamber as described in U.S. Pat. No. 4,570,630A, or by othermeans as described in DE 36 25 685 A. Preferably, the inhalable powdersaccording to the invention which contain physiologically acceptableexcipient in addition to 1 and 2 are packed into capsules (to produceso-called inhalettes) which are used in inhalers as described, forexample, in WO 94/28958.

[0060] A particularly preferred inhaler for using the pharmaceuticalcombination according to the invention in inhalettes is shown in FIG. 1.

[0061] This inhaler (Handyhaler) for inhaling powdered pharmaceuticalcompositions from capsules is characterised by a housing 1 containingtwo windows 2, a deck 3 in which there are air inlet ports and which isprovided with a screen 5 secured via a screen housing 4, an inhalationchamber 6 connected to the deck 3 on which there is a push button 8provided with two sharpened pins 7 and movable counter to a spring 8,and a mouthpiece 12 which is connected to the housing 1, the deck 3 anda cover 11 via a spindle 10 to enable it to be flipped open or shut.

[0062] If the inhalable powders according to the invention are packedinto capsules (inhalers) for the preferred use described above, thequantities packed into each capsule should be 1 to 30 mg, preferably 3to 20 mg, more particularly 5 to 10 mg of inhalable powder per capsule.These capsules contain, according to the invention, either together orseparately, the doses of 1′ and 2 mentioned hereinbefore for each singledose.

[0063] B) Propellant Gas-Driven Inhalation Aerosols Containing theCombinations of Active Substances 1 and 2:

[0064] Inhalation aerosols containing propellant gas according to theinvention may contain substances 1 and 2 dissolved in the propellant gasor in dispersed form. 1 and 2 may be present in separate formulations orin a single preparation, in which 1 and 2 are either both dissolved,both dispersed or only one component is dissolved and the other isdispersed. The propellant gases which may be used to prepare theinhalation aerosols according to the invention are known from the priorart. Suitable propellant gases are selected from among hydrocarbons suchas n-propane, n-butane or isobutane and halohydrocarbons such aschlorinated and/or fluorinated derivatives of methane, ethane, propane,butane, cyclopropane or cyclobutane. The propellant gases mentionedabove may be used on their own or in mixtures thereof. Particularlypreferred propellant gases are halogenated alkane derivatives selectedfrom TG11, TG12, TG134a and TG227. Of the halogenated hydrocarbonsmentioned above, TG134a (1,1,1,2-tetrafluoroethane) and TG227(1,1,1,2,3,3,3-heptafluoropropane) and mixtures thereof are preferredaccording to the invention.

[0065] The propellant-driven inhalation aerosols according to theinvention may also contain other ingredients such as co-solvents,stabilisers, surfactants, antioxidants, lubricants and pH adjusters. Allthese ingredients are known in the art.

[0066] The inhalation aerosols containing propellant gas according tothe invention may contain up to 5 wt.-% of active substance 1 and/or 2.Aerosols according to the invention contain, for example, 0.002 to 5wt.-%, 0.01 to 3 wt.-%, 0.015 to 2 wt.-%, 0.1 to 2 wt.-%, 0.5 to 2 wt.%or 0.5 to 1 wt.-% of active substance 1 and/or 2.

[0067] If the active substances 1 and/or 2 are present in dispersedform, the particles of active substance preferably have an averageparticle size of up to 10 μm, preferably from 0.1 to 5 μm, morepreferably from 1 to 5 μm.

[0068] The propellant-driven inhalation aerosols according to theinvention mentioned above may be administered using inhalers known inthe art (MDIs=metered dose inhalers). Accordingly, in another aspect,the present invention relates to pharmaceutical compositions in the formof propellant-driven aerosols as hereinbefore described combined withone or more inhalers suitable for administering these aerosols. Inaddition, the present invention relates to inhalers which arecharacterised in that they contain the propellant gas-containingaerosols described above according to the invention. The presentinvention also relates to cartridges which are fitted with a suitablevalve and can be used in a suitable inhaler and which contain one of theabove-mentioned propellant gas-containing inhalation aerosols accordingto the invention. Suitable cartridges and methods of filling thesecartridges with the inhalable aerosols containing propellant gasaccording to the invention are known from the prior art.

[0069] C) Propellant-Free Inhalable Solutions or Suspensions Containingthe Combinations of Active Substances 1 and 2 According to theInvention:

[0070] It is particularly preferred to use the active substancecombination according to the invention in the form of propellant-freeinhalable solutions and suspensions. The solvent used may be an aqueousor alcoholic, preferably an ethanolic solution. The solvent may be wateron its own or a mixture of water and ethanol. The relative proportion ofethanol compared with water is not limited but the maximum is up to 70percent by volume, more particularly up to 60 percent by volume and mostpreferably up to 30 percent by volume. The remainder of the volume ismade up of water. The solutions or suspensions containing 1 and 2,separately or together, are adjusted to a pH of 2 to 7, preferably 2 to5, using suitable acids. The pH may be adjusted using acids selectedfrom inorganic or organic acids. Examples of suitable inorganic acidsinclude hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acidand/or phosphoric acid. Examples of particularly suitable organic acidsinclude ascorbic acid, citric acid, malic acid, tartaric acid, maleicacid, succinic acid, fumaric acid, acetic acid, formic acid and/orpropionic acid etc. Preferred inorganic acids are hydrochloric andsulphuric acids. It is also possible to use the acids which have alreadyformed an acid addition salt with one of the active substances. Of theorganic acids, ascorbic acid, fumaric acid and citric acid arepreferred. If desired, mixtures of the above acids may be used,particularly in the case of acids which have other properties inaddition to their acidifying qualities, e.g. as flavourings,antioxidants or complexing agents, such as citric acid or ascorbic acid,for example. According to the invention, it is particularly preferred touse hydrochloric acid to adjust the pH.

[0071] According to the invention, the addition of editic acid (EDTA) orone of the known salts thereof, sodium editate, as stabiliser orcomplexing agent is unnecessary in the present formulation. Otherembodiments may contain this compound or these compounds. In a preferredembodiment the content based on sodium editate is less than 100 mg/100ml, preferably less than 50 mg/100 ml, more preferably less than 20mg/100 ml. Generally, inhalable solutions in which the content of sodiumeditate is from 0 to 10 mg/100 ml are preferred.

[0072] Co-solvents and/or other excipients may be added to thepropellant-free inhalable solutions according to the invention.Preferred co-solvents are those which contain hydroxyl groups or otherpolar groups, e.g. alcohols—particularly isopropyl alcohol,glycols—particularly propyleneglycol, polyethyleneglycol,polypropyleneglycol, glycolether, glycerol, polyoxyethylene alcohols andpolyoxyethylene fatty acid esters. The terms excipients and additives inthis context denote any pharmacologically acceptable substance which isnot an active substance but which can be formulated with the activesubstance or substances in the pharmacologically suitable solvent inorder to improve the qualitative properties of the active substanceformulation. Preferably, these substances have no pharmacological effector, in connection with the desired therapy, no appreciable or at leastno undesirable pharmacological effect. The excipients and additivesinclude, for example, surfactants such as soya lecithin, oleic acid,sorbitan esters, such as polysorbates, polyvinylpyrrolidone, otherstabilisers, complexing agents, antioxidants and/or preservatives whichguarantee or prolong the shelf life of the finished pharmaceuticalformulation, flavourings, vitamins and/or other additives known in theart. The additives also include pharmacologically acceptable salts suchas sodium chloride as isotonic agents.

[0073] The preferred excipients include antioxidants such as ascorbicacid, for example, provided that it has not already been used to adjustthe pH, vitamin A, vitamin E, tocopherols and similar vitamins andprovitamins occurring in the human body.

[0074] Preservatives may be used to protect the formulation fromcontamination with pathogens. Suitable preservatives are those which areknown in the art, particularly cetyl pyridinium chloride, benzalkoniumchloride or benzoic acid or benzoates such as sodium benzoate in theconcentration known from the prior art. The preservatives mentionedabove are preferably present in concentrations of up to 50 mg/100 ml,more preferably between 5 and 20 mg/100 ml.

[0075] Preferred formulations contain, in addition to the solvent waterand the combination of active substances 1 and 2, only benzalkoniumchloride and sodium editate. In another preferred embodiment, no sodiumeditate is present.

[0076] The propellant-free inhalable solutions according to theinvention are administered in particular using inhalers of the kindwhich are capable of nebulising a small amount of a liquid formulationin the therapeutic dose within a few seconds to produce an aerosolsuitable for therapeutic inhalation. Within the scope of the presentinvention, preferred inhalers are those in which a quantity of less than100 μL, preferably less than 50 μL, more preferably between 20 and 30 μLof active substance solution can be nebulised in preferably one sprayaction to form an aerosol with an average particle size of less than 20μm, preferably less than 10 μm, in such a way that the inhalable part ofthe aerosol corresponds to the therapeutically effective quantity.

[0077] An apparatus of this kind for propellant-free delivery of ametered quantity of a liquid pharmaceutical composition for inhalationis described for example in International Patent Application WO 91/14468and also in WO 97/12687 (cf. in particular FIGS. 6a and 6 b). Thenebulisers (devices) described therein are known by the name Respimat®.

[0078] This nebuliser (Respimat®) can advantageously be used to producethe inhalable aerosols according to the invention containing thecombination of active substances 1 and 2. Because of its cylindricalshape and handy size of less than 9 to 15 cm long and 2 to 4 cm wide,this device can be carried at all times by the patient. The nebulisersprays a defined volume of pharmaceutical formulation using highpressures through small nozzles so as to produce inhalable aerosols.

[0079] The preferred atomiser essentially consists of an upper housingpart, a pump housing, a nozzle, a locking mechanism, a spring housing, aspring and a storage container, characterised by

[0080] a pump housing which is secured in the upper housing part andwhich comprises at one end a nozzle body with the nozzle or nozzlearrangement,

[0081] a hollow plunger with valve body,

[0082] a power takeoff flange in which the hollow plunger is secured andwhich is located in the upper housing part,

[0083] a locking mechanism situated in the upper housing part,

[0084] a spring housing with the spring contained therein, which isrotatably mounted on the upper housing part by means of a rotarybearing,

[0085] a lower housing part which is fitted onto the spring housing inthe axial direction.

[0086] The hollow plunger with valve body corresponds to a devicedisclosed in WO 97/12687. It projects partially into the cylinder of thepump housing and is axially movable within the cylinder. Reference ismade in particular to FIGS. 1 to 4, especially FIG. 3, and the relevantparts of the description. The hollow plunger with valve body exerts apressure of 5 to 60 Mpa (about 50 to 600 bar), preferably 10 to 60 Mpa(about 100 to 600 bar) on the fluid, the measured amount of activesubstance solution, at its high pressure end at the moment when thespring is actuated. Volumes of 10 to 50 microlitres are preferred, whilevolumes of 10 to 20 microlitres are particularly preferred and a volumeof 15 microlitres per spray is most particularly preferred.

[0087] The valve body is preferably mounted at the end of the hollowplunger facing the valve body.

[0088] The nozzle in the nozzle body is preferably microstructured, i.e.produced by microtechnology. Microstructured valve bodies are disclosedfor example in WO-94/07607; reference is hereby made to the contents ofthis specification, particularly FIG. 1 therein and the associateddescription.

[0089] The valve body consists for example of two sheets of glass and/orsilicon firmly joined together, at least one of which has one or moremicrostructured channels which connect the nozzle inlet end to thenozzle outlet end. At the nozzle outlet end there is at least one roundor non-round opening 2 to 10 microns deep and 5 to 15 microns wide, thedepth preferably being 4.5 to 6.5 microns while the length is preferably7 to 9 microns.

[0090] In the case of a plurality of nozzle openings, preferably two,the directions of spraying of the nozzles in the nozzle body may extendparallel to one another or may be inclined relative to one another inthe direction of the nozzle opening. In a nozzle body with at least twonozzle openings at the outlet end the directions of spraying may be atan angle of 20 to 160° to one another, preferably 60 to 150°, mostpreferably 80 to 100°. The nozzle openings are preferably arranged at aspacing of 10 to 200 microns, more preferably at a spacing of 10 to 100microns, most preferably 30 to 70 microns. Spacings of 50 microns aremost preferred. The directions of spraying will therefore meet in thevicinity of the nozzle openings.

[0091] The liquid pharmaceutical preparation strikes the nozzle bodywith an entry pressure of up to 600 bar, preferably 200 to 300 bar, andis atomised into an inhalable aerosol through the nozzle openings. Thepreferred particle or droplet sizes of the aerosol are up to 20 microns,preferably 3 to 10 microns.

[0092] The locking mechanism contains a spring, preferably a cylindricalhelical compression spring, as a store for the mechanical energy. Thespring acts on the power takeoff flange as an actuating member themovement of which is determined by the position of a locking member. Thetravel of the power takeoff flange is precisely limited by an upper andlower stop. The spring is preferably biased, via a power step-up gear,e.g. a helical thrust gear, by an external torque which is produced whenthe upper housing part is rotated counter to the spring housing in thelower housing part. In this case, the upper housing part and the powertakeoff flange have a single or multiple V-shaped gear.

[0093] The locking member with engaging locking surfaces is arranged ina ring around the power takeoff flange. It consists, for example, of aring of plastic or metal which is inherently radially elasticallydeformable. The ring is arranged in a plane at right angles to theatomiser axis. After the biasing of the spring, the locking surfaces ofthe locking member move into the path of the power takeoff flange andprevent the spring from relaxing. The locking member is actuated bymeans of a button. The actuating button is connected or coupled to thelocking member. In order to actuate the locking mechanism, the actuatingbutton is moved parallel to the annular plane, preferably into theatomiser; this causes the deformable ring to deform in the annual plane.Details of the construction of the locking mechanism are given in WO97/20590.

[0094] The lower housing part is pushed axially over the spring housingand covers the mounting, the drive of the spindle and the storagecontainer for the fluid.

[0095] When the atomiser is actuated the upper housing part is rotatedrelative to the lower housing part, the lower housing part taking thespring housing with it. The spring is thereby compressed and biased bymeans of the helical thrust gear and the locking mechanism engagesautomatically. The angle of rotation is preferably a whole-numberfraction of 360 degrees, e.g. 180 degrees. At the same time as thespring is biased, the power takeoff part in the upper housing part ismoved along by a given distance, the hollow plunger is withdrawn insidethe cylinder in the pump housing, as a result of which some of the fluidis sucked out of the storage container and into the high pressurechamber in front of the nozzle.

[0096] If desired, a number of exchangeable storage containers whichcontain the fluid to be atomised may be pushed into the atomiser oneafter another and used in succession. The storage container contains theaqueous aerosol preparation according to the invention.

[0097] The atomising process is initiated-by pressing gently on theactuating button. As a result, the locking mechanism opens up the pathfor the power takeoff member. The biased spring pushes the plunger intothe cylinder of the pump housing. The fluid leaves the nozzle of theatomiser in atomised form.

[0098] Further details of construction are disclosed in PCT ApplicationsWO 97/12683 and WO 97/20590, to which reference is hereby made.

[0099] The components of the atomiser (nebuliser) are made of a materialwhich is suitable for its purpose. The housing of the atomiser and—ifits operation permits, other parts as well are preferably made ofplastics, e.g. by injection moulding. For medicinal purposes,physiologically safe materials are used.

[0100]FIGS. 2a/b attached to this patent application, which areidentical to FIGS. 6a/b of WO 97/12687, show the nebuliser (Respimat®)which can advantageously be used for inhaling the aqueous aerosolpreparations according to the invention.

[0101]FIG. 2a shows a longitudinal section through the atomiser with thespring biased while FIG. 2b shows a longitudinal section through theatomiser with the spring relaxed.

[0102] The upper housing part (51) contains the pump housing (52) on theend of which is mounted the holder (53) for the atomiser nozzle. In theholder is the nozzle body (54) and a filter (55). The hollow plunger(57) fixed in the power takeoff flange (56) of the locking mechanismprojects partially into the cylinder of the pump housing. At its end thehollow plunger carries the valve body (58). The hollow plunger is sealedoff by means of the seal (59). Inside the upper housing part is the stop(60) on which the power takeoff flange abuts when the spring is relaxed.On the power-takeoff flange is the stop (61) on which the power takeoffflange abuts when the spring is biased. After the biasing of the springthe locking member (62) moves between the stop (61) and a support (63)in the upper housing part. The actuating button (64) is connected to thelocking member. The upper housing part ends in the mouthpiece (65) andis sealed off by means of the protective cover (66) which can be placedthereon.

[0103] The spring housing (67) with compression spring (68) is rotatablymounted on the upper housing part by means of the snap-in lugs (69) androtary bearing. The lower housing part (70) is pushed over the springhousing. Inside the spring housing is the exchangeable storage container(71) for the fluid (72) which is to be atomised. The storage containeris sealed off by the stopper (73) through which the hollow plungerprojects into the storage container and is immersed at its end in thefluid (supply of active substance solution).

[0104] The spindle (74) for the mechanical counter is mounted in thecovering of the spring housing. At the end of the spindle facing theupper housing part is the drive pinion (75). The slider (76) sits on thespindle.

[0105] The nebuliser described above is suitable for nebulising theaerosol preparations according to the invention to produce an aerosolsuitable for inhalation.

[0106] If the formulation according to the invention is nebulised usingthe method described above (Respimat®) the quantity delivered shouldcorrespond to a defined quantity with a tolerance of not more than 25%,preferably 20% of this amount in at least 97%, preferably at least 98%of all operations of the inhaler (spray actuations). Preferably, between5 and 30 mg of formulation, most preferably between 5 and 20 mg offormulation are delivered as a defined mass on each actuation.

[0107] However, the formulation according to the invention may also benebulised by means of inhalers other than those described above, e.g.jet stream inhalers or other stationary nebulisers.

[0108] Accordingly, in a further aspect, the invention relates topharmaceutical formulations in the form of propellant-free inhalablesolutions or suspensions as described above combined with a devicesuitable for administering these formulations, preferably in conjunctionwith the Respimat®. Preferably, the invention relates to propellant-freeinhalable solutions or suspensions characterised by the combination ofactive substances 1 and 2 according to the invention in conjunction withthe device known by the name Respimat®. In addition, the presentinvention relates to the above-mentioned devices for inhalation,preferably the Respimat®, characterised in that they contain thepropellant-free inhalable solutions or suspensions according to theinvention as described hereinbefore.

[0109] The propellant-free inhalable solutions or suspensions accordingto the invention may take the form of concentrates or sterile inhalablesolutions or suspensions ready for use, as well as the above-mentionedsolutions and suspensions designed for use in a Respimat®. Formulationsready for use may be produced from the concentrates, for example, by theaddition of isotonic saline solutions. Sterile formulations ready foruse may be administered using energy-operated fixed or portablenebulisers which produce inhalable aerosols by means of ultrasound orcompressed air by the Venturi principle or other principles.

[0110] Accordingly, in another aspect, the present invention relates topharmaceutical compositions in the form of propellant-free inhalablesolutions or suspensions as described hereinbefore which take the formof concentrates or sterile formulations ready for use, combined with adevice suitable for administering these solutions, characterised in thatthe device is an energy-operated free-standing or portable nebuliserwhich produces inhalable aerosols by means of ultrasound or compressedair by the Venturi principle or other methods.

[0111] The Examples which follow serve to illustrate the presentinvention in more detail without restricting the scope of the inventionto the following embodiments by way of example.

[0112] Starting Materials

[0113] Tiotropium Bromide:

[0114] The tiotropium bromide used in the following formulationsexamples may be obtained as described in European Patent Application 418716 A1.

[0115] In order to prepare the inhalable powders according to theinvention, crystalline tiotropium bromide monohydrate may also be used.This crystalline tiotropium bromide monohydrate may be obtained by themethod described below.

[0116] 15.0 kg of tiotropium bromide are placed in 25.7 kg of water in asuitable reaction vessel. The mixture is heated to 80-90° C. and stirredat constant temperature until a clear solution is formed. Activatedcharcoal (0.8 kg) moistened with water is suspended in 4.4 kg of water,this mixture is added to the solution containing the tiotropium bromideand the resulting mixture is rinsed with 4.3 kg of water. The mixturethus obtained is stirred for at least 15 minutes at 80-90° C. and thenfiltered through a heated filter into an apparatus preheated to anexternal temperature of 70° C. The filter is rinsed with 8.6 kg ofwater. The contents of the apparatus are cooled at 3-5° C. for every 20minutes to a temperature of 20-25° C. The apparatus is cooled further to10-15° C. using cold water and crystallisation is completed by stirringfor at least another hour. The crystals are isolated using a suctionfilter dryer, the crystal slurry isolated is washed with 9 litres ofcold water (10-15° C.) and cold acetone (10-15° C.). The crystalsobtained are dried at 25° C. in a nitrogen current over a period of 2hours. Yield: 13.4 kg of tiotropium bromide monohydrate (86% of theory).

[0117] The crystalline tiotropium bromide monohydrate thus obtained ismicronised by known methods in order to prepare the active substance inthe form of the average particle size corresponding to thespecifications according to the invention.

[0118] In order to prepare the compounds 2 mentioned within the scope ofthe present invention and not known in the prior art:

[0119]N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide

[0120] a) 33 g of 1-benzyl-4-piperidone and 15 g of 3-aminopropanol arecombined with a catalytic amount of p-toluenesulphonic acid in 300 ml oftoluene and refluxed using the water separator until the calculatedamount of water has been drawn off. Then the toluene is distilled off,the residue is dissolved in 250 ml of alcohol and cooled to about 5° C.A total of 6.6 g of sodium borohydride is added batchwise with stirringand the mixture is stirred for 30 hours at ambient temperature. It iscombined with 50 ml of acetone, stirred for about half an hour and thenthe solvents are eliminated in vacuo. The residue is combined with 100ml of water and extracted twice with 150 ml of methylene chloride. Thecombined organic phases are dried. The mixture is filtered, the solventis eliminated in vacuo, the residue is taken up in 80 ml of alcohol,combined with 40 ml of 32% hydrochloric acid, diluted with acetone andstirred for about an hour. The crystals then precipitated are suctionfiltered and dried. 1-Benzyl-4-(3-hydroxypropylamino)-piperidine isobtained as the dihydrochloride.

[0121] b) From 47.4 g of1-benzyl-4-(3-hydroxypropylamino)-piperidine-dihydrochloride the base isliberated, combined with 63 ml of 85% formic acid and 22 ml of 37%formaldehyde solution and stirred for two hours at about 90-100° C. Themixture is left to cool, 37 ml of formic acid and 11 ml of formaldehydesolution are added and it is stirred for another hour at about 100-110°C. It is left to cool, combined with 150 ml of methanol, made alkalinewith about 270 ml of 32% sodium hydroxide solution with cooling andstirred for about another 30 minutes at 40-50° C. and then the methanolis distilled off. The residue is extracted with twice 100 ml ofmethylene chloride, the combined methylene chloride phases are dried,filtered and freed from solvent in vacuo. The residue is taken up in 80ml Ethanol, acidified with 34 ml of 32% hydrochloric acid, combined with100 ml of acetone and stirred. As soon as crystals have beenprecipitated more acetone is added. The precipitate is suction filtered,washed with acetone and dried. 42.8 g of1-benzyl-4-[-(3-hydroxypropyl)-methylamino]-piperidine-dihydrochlorideare obtained in the form of a solid.

[0122] c) 42.8 g of1-benzyl-4-[(3-hydroxypropyl)-methylamino]-piperidine-dihydrochlorideare dissolved in 450 ml of methanol, combined with 5 g of 5%palladium-charcoal and hydrogenated at about 50° C. with hydrogen at 4-5bar. The catalyst is filtered off, the methanol is distilled off and theresidue is stirred in acetone. Ether is added, the mixture is left tostand for about two hours and then the crystals are suction filtered.28.7 g of 4-[-(3-hydroxypropyl)-methylamino]-piperidine-dihydrochlorideare obtained in the form of a solid.

[0123] d) 9 g of4-[-(3-hydroxypropyl)-methylamino]-piperidine-dihydrochloride aredissolved together with 14.5 g ofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-methanesulphonyloxy-N-methyl-2-phenyl-acetamide(prepared analogously to the method described in WO 99/62893) in 125 mlDMF, combined with 20.5 g of potassium carbonate and stirred for aboutfour hours at 80-90° C. After cooling the mixture is poured onto ice,extracted twice with 150 ml of ethyl acetate, the combined organicphases are twice washed with water and dried. The desiccant is filteredoff, the solvent is eliminated in vacuo and the residue ischromatographed with methylene chloride/methanol/conc. ammonia solution95:5:0.5 over silica gel. The uniform fractions according to TLC arecombined and freed from solvent in vacuo. The residue of 9.5 g is takenup in methanol and combined with 3.4 g of fumaric acid. Then themethanol is distilled off apart from a small residue, acetone is addedand the resulting mixture is stirred for about 30 minutes. The crystalsprecipitated are suction filtered, washed with acetone and ether anddried. 9 g ofN-2-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamideare obtained as the colourless sesquifumarate, m.p. 139-144° C.

[0124]¹H-NMR (250 MHz, CD₃OD) δ=7.85−7.26 (8H, m); 6,71 (3H, s); 4.50;4.49 (1H, 2s); 3.67 (2H, t, J =6,0 Hz); 3.89-3.09 (7H, m); 3.21; 3.00(4H, m);2.69; 2.94 (3H,); 2.77 (3H, s); 2.49-1.63 (6H, m) ; most of thesignals are cleaved as a result of amide rotation.

[0125]N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide

[0126] a) 2.75 g of 2-aminopropan-1,3-diol and 5.9 g of1-benzyl-4-piperidone are dissolved in 60 ml of methylene chloride andwhile cooling with ice a total of 9.9 g of sodium triacetoxyborohydrideare added batchwise. The mixture is left to stand overnight at ambienttemperature. 60 ml of methylene chloride and some water are added, thenconc. hydrochloric acid is added while cooling with ice until an acidreaction is obtained. The mixture is stirred for about another 15 min.with cooling and then made clearly alkaline with 4 N sodium hydroxidesolution. The aqueous phase is separated off, the organic phase iswashed with a very little water, dried over sodium sulphate and freedfrom solvent in vacuo. 8 g of substance are obtained which arechromatographed with methylene chloride/methanol 8:2 over 150 g ofsilica gel. The uniform fractions according to TLC are combined andfreed from solvent in vacuo. 7.3 g of1-benzyl-4-(1,3-dihydroxyprop-2-ylamino)-piperidine are obtained.

[0127] b) 34.5 g of 1-benzyl-4-(1,3-dihydroxyprop-2-ylamino)-piperidineare dissolved in 400 ml of methanol, combined with 3.4 g of 20%palladium-charcoal and hydrogenated with hydrogen at 24-28° C. under 2.2bar. Then the catalyst is filtered off and the solvent is eliminated invacuo. 22.7 g of 4-(1,3-dihydroxyprop-2-ylamino)-piperidine are obtainedas an oil, which is used for the next reaction without any furtherpurification.

[0128] c) 9 g of 4-(1,3-dihydroxyprop-2-ylamino)-piperidine are reactedwith 22.7 g ofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-methanesulphonyloxy-N-methyl-2-phenyl-acetamidein 110 ml DMF with 7.2 ml of triethylamine as base analogously toExample 1, reaction time 5 h at 60-70° C. The crude product ischromatographed over silica gel with methylene chloride/methanol 9:1.The uniform fractions according to TLC are combined. The oily residue istaken up in ethyl acetate and a little water, the aqueous phase is madealkaline with conc. sodium hydroxide solution. The aqueous phase isseparated off, the organic phase is dried and freed from solvent invacuo. The residue is brought to crystallisation in acetone withmethanesulphonic acid. 11 g ofN-2-(3,5-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamideare obtained as the colourless methanesulphonate.

[0129]¹H-NMR (250 MHz, CD₃OD) δ7.95-7.31 (8H, m); 4.37; 4.31 (¹H, 2s);3.77 (5H, m); 3.28 (1H, m) ; 3.05; 3.01 (4H, m); 2.74 (3H, s); 3.45-2.08(4H, m); 2.07-1.52 (4H, m). Most of the signals are cleaved as a resultof amide rotation.

[0130]N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamide

[0131] a) 19 g of 1-benzyl-4-piperidone are combined with 10 g Raneynickel (moistened by rinsing with a little methanol) and 40 g ofmethylamine in 150 ml of water and hydrogenated for eight hours atambient temperature under 5 bars of hydrogen. Then the catalyst isfiltered off, methanol and excess methylamine are eliminated in vacuo.The mixture is extracted with ethyl acetate, the organic phase is driedover sodium sulphate, filtered and evaporated down in vacuo. 19.2 g of ayellow oil are obtained, which is used for the next reaction without anyfurther purification.

[0132] b) 18.9 g of 1-benzyl-4-methylaminopiperidine as the oil preparedaccording to a) are taken up in 250 ml of methanol and combined with 8.3g of cyclopropanecarboxaldehyde and 11.3 g of sodium cyanoborohydride.The mixture is stirred for 5 hours at 40-50° C., then for about another16 hours at ambient temperature. It is then acidified with 2 Nhydrochloric acid, evaporated to dryness in vacuo and the residue istaken up in water. It is washed with ether, made alkaline withconcentrated sodium hydroxide solution and extracted with ether/ethylacetate. The organic extract is dried over sodium sulphate and freedfrom the solvents in vacuo. 22.7 g1-benzyl-4-(dyclopropylmethyl-methyl-amino)-piperidine are obtained as ayellowish oil.

[0133] c) 21.5 g of the oil prepared according to b) are taken up in 230ml of methanol, combined with 2.5 g of 10% palladium-charcoal andhydrogenated at 60° C. under 5 bars of hydrogen. After 3.5 hours thecatalyst is renewed and the mixture is hydrogenated for a further fivehours at 80° C. under 5 bars of hydrogen. Then the catalyst is filteredoff and the solvent is eliminated in vacuo.4-(Cyclopropylmethyl-methyl-amino)-piperidine is precipitated from theresidue as the dihydrochloride with ethanolic hydrochloric acid. It iswashed with ether, dried in vacuo and 12.5 g of colourless crystals areobtained.

[0134] d) 11.9 g of4-(Cyclopropylmethyl-methyl-amino)-piperidine-dihydrochloride are takenup in 400 ml of acetone and combined with 21.7 g ofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-methanesulphonyloxy-N-methyl-2-phenyl-acetamideand 21 ml of triethylamine. The mixture is refluxed for 16 hours, thenthe solvent is eliminated in vacuo and the residue is taken up in 10%sodium hydrogen carbonate solution. It is extracted with ether, thecombined organic phases are dried over sodium sulphate and freed fromsolvent in vacuo. The residue is filtered with ethylacetate/methanol/conc. ammonia solution 70:30:1 over silica gel, freedfrom the solvents in vacuo and brought to crystallisation in methanolwith fumaric acid. The precipitate is suction filtered, washed withmethanol and dried in vacuo. 9.3 g ofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamideare obtained as the sesquifumarate.

[0135]¹H-NMR (250 MHz, CDCl₃) δ7.71-7.14 (8H, m); 4.14 (1H, s);3.81-2.46 (11H, m); 2.90; 2.82 (3H, 2s); 2.36 (3H, s); 2.23-1.48 (4H,m); 0.82 (1H, m); 0.48; 0.07 (4H, 2m). Most of the signals are cleavedas a result of amide rotation.

[0136]N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl)-N-methyl-2-phenyl-acetamide

[0137] a) 6 g of 2-hydroxyethyl-3-hydroxypropylamine and 18.9 g of1-benzyl-4-piperidone are taken up in 250 ml methylene chloride and at0° C. combined with 21.2 g of sodium triacetoxyborohydride. The mixtureis stirred overnight at ambient temperature, then acidified with 2 Nhydrochloric acid and made alkaline with concentrated sodium hydroxidesolution. It is extracted with methylene chloride, the extract is driedover sodium sulphate and the solvent is eliminated in vacuo. The residueis chromatographed over silica gel with ethyl acetate/methanol/conc.ammonia solution 20:80:1. The uniform fractions according to TLC arecombined and freed from solvent in vacuo. 2.3 g of1-benzyl-4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidine areobtained as an oil.

[0138] b) 13.3 g of1-benzyl-4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidine arecombined with 1.5 g of 10% palladium-charcoal in 150 ml of methanol andhydrogenated at ambient temperature for 18 hours under 5 bars ofhydrogen. The catalyst is renewed after 8 hours and 15 hours. Then thecatalyst is filtered off and the filtrate is freed from solvent invacuo. 4-[(2-Hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidine areobtained as an oil, which is used for the next reaction without anyfurther purification.

[0139] c) 6.4 g of the oil of4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidine preparedaccording to b) are taken up in 300 ml of acetone, combined with 13.8 gofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-methanesulphonyloxy-N-methyl-2-phenyl-acetamideand 33 ml of triethylamine and refluxed for 6 hours. The mixture iscooled, the solvent is eliminated in vacuo, the residue is stirred into10% sodium hydrogen carbonate solution and extracted with ethyl acetate.The combined organic phases are dried over sodium sulphate, the solventis eliminated in vacuo and the residue is chromatographed over silicagel with ethyl acetate/methanol/conc. ammonia solution 20:80:1. Theuniform fractions according to TLC are combined and freed from thesolvents in vacuc. 8.4 g ofN-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamideare obtained as a yellowish-brown oil.

[0140]¹H-NMR (250 MHz, CDCl₃) δ=7.78-7.24 (8H, m); 4.24 (1H, s); 3.78(2H, m); 3.61 (2H, m); 3.64 (1H, m); 2.98; 2.87 (3H, 2s); 2.93 (4H, m);2.74; 2.65 (4H, 2m); 2.88-1.77 (4H, m); 1.67 (2H, m); 1.76-1.45 (4H, m).Most of the signals are cleaved as a result of amide rotation.

[0141](S)-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide

[0142] a) 16.5 g of 3-aminopropanol and 41.7 g of 1-benzyl-4-piperidoneare dissolved in 350 ml methylene chloride and at about 10° C. 56 g ofsodium triacetoxy-borohydride are slowly added. The mixture is stirredovernight at ambient temperature, then acidified with dilutehydrochloric acid with cooling and subsequently made alkaline with conc.sodium hydroxide solution. The organic phase is separated off, theaqueous phase is washed once again with 150 ml of methylene chloride.The combined organic phases are dried over sodium sulphate and freedfrom solvent in vacuo. 32 g1-benzyl-4-(3-hydroxy-propylamino)-piperidine are obtained as a yellowoil which is used in the next reaction step without any furtherpurification.

[0143] b) 13.4 g of 1-benzyl-4-(3-hydroxy-propylamino)-piperidine fromthe previous reaction are dissolved together with 3.8 g ofcyclopropanecarboxaldehyde in 250 ml of methanol and at 0° C. combinedwith 5.1 g of sodium cyanoborohydride. The mixture is stirred overnightat ambient temperature, then acidified with dilute hydrochloric acidwith cooling and evaporated down in vacuo. The mixture is then madealkaline with conc. sodium hydroxide solution and extracted three timeswith 40 ml of methylene chloride. The combined organic phases are driedover sodium sulphate, filtered and freed from solvent in vacuo. Theresidue is filtered over silica gel with ethyl acetate/methanol/conc.ammonia solution 20:80:1. After the solvent has been eliminated 10.2 gof 1-benzyl-4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidineare obtained as a yellow oil.

[0144] c) 10.2 g of1-benzyl-4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidine arecombined with 2 g of 20% palladium-charcoal in 100 ml of methanol andhydrogenated at 60° C. for 4 h under 5 bars of hydrogen. The catalyst isseparated off, the solvent is eliminated in vacuo and 7.3 g of4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidine are obtainedas a yellow oil.

[0145] d) 4.7 g of4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidine are stirredtogether with 9.6 g of(R)-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-methanesulphonyloxy-N-methyl-2-phenyl-acetamide(prepared from D-(−)-mandelic acid) and 3.4 ml of triethylamine in 200ml of acetone for four hours at 65° C. The mixture is evaporated down invacuo, combined with 100 ml of saturated sodium hydrogen carbonatesolution and extracted with ethyl acetate. The combined organicfractions are dried over sodium sulphate and freed from solvent invacuo. The residue is chromatographed with methylene chloride/methanol1:1 over silica gel. The uniform fractions according to TLC arecollected and the solvents are eliminated in vacuo. 5.5 g of(S)-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamideare obtained as a yellowish-brown oil, [α]_(D) ²⁰=+29.6°

[0146]¹H-NMR (250 MHz, CDCl₃) δ=7.78-7.26 (8H, m), 4.24 (1H, s), 3.78(2H, m); 3,63 (2H, m); 3.50 (1H, m); 2.96; 2.88 (3H, 2s); 2.93 (4H, m);2.88-1.77 (5H, m); 2.37 (2H, d, J 6.0 Hz); 1.79-1.45 (6H, m); 0.87 (1H,m); 0.52; 0.12 (4H, 2m). Most of the signals are cleaved as a result ofamide rotation.

[0147] Examples of Formulations A) Inhalable powders: Ingredients μg percapsule 1) Tiotropium bromide 10.8 NK₁-receptor antagonist 27.9 Lactose4961.3 Total 5000 2) Tiotropium bromide 21.7 NK₁-receptor antagonist55.9 Lactose 4922.4 Total 5000 3) Tiotropium bromide ×H₂O 22.5NK₁-receptor antagonist 55.9 Lactose 4921.6 Total 5000 4) Tiotropiumbromide 21.7 NK₁-receptor antagonist 55.9 Lactose 4922.4 Total 5000

[0148] B) Propellant gas-containing aerosols for inhalation: Ingredientswt % 1) Suspension aerosol: Tiotropium bromide 0.015 NK₁-receptorantagonist 0.066 Soya lecithin 0.2  TG 11:TG12 = 2:3 ad 100 2)Suspension aerosol: Tiotropium bromide 0.029 NK₁-receptor antagonist0.033 absolute ethanol 0.5  isopropyl myristate 0.1  TG 227 ad 100 3)Suspension aerosol: Tiotropium bromide 0.029 NK₁-receptor antagonist0.033 absolute ethanol 0.5  isopropyl myristate 0.1  TG 227 ad 100 4)Suspension aerosol: Tiotropium bromide 0.029 NK₁-receptor antagonist0.033 absolute ethanol 0.5  isopropyl myristate 0.1  TG 227 ad 100

What is claimed is:
 1. A pharmaceutical composition of matter comprising one or more anticholinergics and one or more NK₁-receptor antagonists as active components of the pharmaceutical composition, wherein one or more of the active components may be an enantiomer, a mixture of enantiomers, a racemate, a solvate or an hydrate.
 2. The pharmaceutical composition as recited in claim 1 wherein the pharmaceutical composition further comprises a pharmaceutically acceptable excipient.
 3. The pharmaceutical composition as recited in claim 1 wherein the active components are present together in a single formulation.
 4. The pharmaceutical composition as recited in claim 1 wherein the active components are in at least two separate formulations.
 5. The pharmaceutical composition as recited in claim 1 wherein the anticholinergic is selected from the group consisting of one or more tiotropium salts, one or more oxitropium salts and one or more ipratropium salts.
 6. The pharmaceutical composition as recited in claim 5 wherein the anticholinergic is one or more tiotropium salts.
 7. The pharmaceutical composition as recited in claim 1 wherein one or more anticholinergic is present in the form of a chloride, bromide, iodide, methanesulphonate, paratoluene sulphonate or a methyl sulphate.
 8. The pharmaceutical composition as recited in claim 7 wherein one or more anticholinergics is present in the form of a bromide.
 9. The pharmaceutical composition as recited in claim 1 wherein one or more NK₁-receptor antagonists is selected from among BIIF 1149, CP-122721, FK-888, NKP 608C, NKP 608A, CGP 60829, SR 48968(Saredutant), SR 140333 (Nolpitantium besilate/chloride), LY 303 870 (Lanepitant), MEN-11420 (Nepadutant), SB 223412, MDL-105172A, MDL-103896, MEN-11149, MEN-11467, DNK 333A, SR-144190, YM-49244, YM-44778, ZM-274773, MEN-10930, S-19752, Neuronorm, YM-35375, DA-5018, MK-869, L-754030, CJ-11974, L-758298, DNK-33A, 6b-I, CJ-11974, TAK-637, GR 205171, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide, BIIM1310 N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide and the arylglycinamide derivatives of general formula 3

wherein R¹ and R² together with the N to which they are bound form a ring of formula

wherein r and s are 2 or 3; R⁶ denotes H, —C₁-C₅-alkyl, C₃-C₅-alkenyl, propynyl, hydroxy(C₂-C₄)alkyl, methoxy(C₂-C₄)alkyl, di(C₁-C₃)alkylamino(C₂-C₄)alkyl, amino(C₂-C₄)alkyl, amino, di(C₁-C₃)alkylamino, monofluoro to perfluoro(C₁-C₂)alkyl, N-methylpiperidinyl, pyridyl, pyrimidinyl, pyrazinyl or pyridazinyl, R⁷ has one of the meanings (a) to (d), (a) hydroxy (b) 4-piperidinopiperidyl, (c)

wherein R¹⁶ and R¹⁷ independently of each other denote H, (C₁-C₄)alkyl, (C₃-C₆)cycloalkyl, hydroxy(C₂-C₄)alkyl, dihydroxy(C₂-C₄)alkyl, (C₁-C₃)alkoxy(C₂-C₄)alkyl, phenyl(C₁-C₄)alkyl or di(C₁-C₃)alkylamino(C₂-C₄)alkyl, R⁸ denotes H, optionally in the form of the enantiomers and mixtures of enantiomers thereof, optionally in the form of the racemates thereof.
 10. The pharmaceutical composition as recited in claim 1 wherein one or more NK₁-receptor antagonists is selected from among BIIF 1149, CP-122721, CGP 60829, MK-869, CJ-11974, GR 205171, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(3-hydroxy-propyl)-methyl-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide, BIIM1310 N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(cyclopropylmethyl-methyl-amino)-piperidin-1-yl]-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[(2-hydroxy-ethyl)-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide, N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-{4-[cyclopropylmethyl-(3-hydroxy-propyl)-amino]-piperidin-1-yl}-N-methyl-2-phenyl-acetamide and the arylglycinamide derivatives of general formula 3, wherein R¹ and R² together with the N to which they are bound form a ring of formula

wherein s is 2 or 3; R⁷ denotes a group

wherein R¹⁶ and R¹⁷ independently of each other denote H, (C₁-C₄)alkyl, (C₃-C₆)cycloalkyl, hydroxy(C₂-C₄)alkyl, dihydroxy(C₂-C₄)alkyl, (C₁-C₃)alkoxy(C₂-C₄)alkyl, phenyl(C₁-C₄)alkyl or di(C₁-C₃)alkylamino(C₂-C₄)alkyl, R⁸ denotes H, optionally in the form of the enantiomers and mixtures of enantiomers thereof and optionally in the form of the racemates thereof.
 11. The pharmaceutical composition as recited in claim 1 wherein one or more NK₁-receptor antagonists is (S)-N-[2-(3,5-bis-trifluoromethyl-phenyl)-ethyl]-2-[4-(2-hydroxy-1-hydroxymethyl-ethylamino)-piperidin-1-yl]-N-methyl-2-phenylacetamide or an acid addition salt thereof.
 12. The pharmaceutical composition as recited in claim 1 wherein the weight ratio of the anticholineigic to the NK₁-receptor antagonist is in the range from about 1:300 to about 50:1.
 13. The pharmaceutical composition as recited in claim 12 wherein the weight ratio of the anticholinergic to the NK₁-resceptor antagonist is about 1:250 to about 40:1.
 14. The pharmaceutical composition as recited in claim 1 which is a formulation suitable for inhalation. 